Lab Week 2018

Labs: the final frontier. These are the voyages of lab-techs everywhere. Our continuing mission: to explore strange new orders, to seek out new tests and new sero-preparations, to boldly notify floor clinicians about sample hemolysis for redraw…

Or at least that’s close enough to Gene Roddenberry’s vision for futurism in exploration—except instead of starships, we’re talking Star Labs. Happy 2018 Lab Week everybody, and thanks for checking back in!

Okay, so here’s something a little bit different. Different from my usual Zika or medical school posts, this piece is a celebration of several lab “truths” which I know many of us share. It seems like one of the overarching themes I’ve encountered regarding laboratory operation (and appreciation) is communication. Expectations and needs aren’t always communicated effectively across different medical disciplines and scopes. A while back I thought of 40 things every lab professional should know, but I’d like to expand on that a bit.

How many times have you said or encountered any of the following:

Why does the blue top have to be full, if the other ones weren’t as full?

I just put some blood from the lavender top into the tiger top—patient is a hard stick…

I’m checking on results for the patient in room 123…no, I don’t have their MRN…

Can you please add on a serum lactic acid, there was a BMP from yesterday?

This C. Diff sample is solid…

Why are some hospitals’ rapid flu-tests done with just the swab of a swab kit, a little aliquot of saline from an IV push syringe, and a wasted no gel SST?

Are the results ready for the biopsy we did just now?

Do we have a critical value range for ESR?

We haven’t had an in-service on running POCT Glucose controls, so we haven’t done them yet

I didn’t want the tubes to leak in transit, so I used the labels as tape to keep the caps on!

In order to get SUPER GOLD STAR STROKE AND GOUT CENTER accreditation, we have to slash TATs by 40%

Captain Hematologist Jean Luc Picard (front) pleads with a clinician that only wants the WBC and H/H from a clotted CBC. Second Officer Riker (bottom left) smiles because he knows clots are dangerous for most analyzers. Lt. Operations Officer Worf (top right) agrees firmly for the sake of honor and quality assurance. An ensign trains on urinalysis (top left). [Source: StarTrekTNG]I’m sure by now you realize I could go on, and on, and on…There are always issues in laboratory medicine that don’t always translate well between floor clinicians and laboratory staff. It’s a tale as old as time. And, until we do develop universal translator technology, it will remain somewhat of a barrier to improving workflow. So how to we fix it? I argue it starts with Lab Week.

Lab Week is supposed to celebrate the clinicians, laboratory professionals, and ancillary staff that work diligently to produce results. Hundreds of thousands of laboratorians work throughout the country and are highly-trained, well educated professionals who use their expertise to diagnose and monitor treatments. Quality medical testing and exceptional care are part of the core values that each of us are celebrated for every year in April! Let me be clear, we are not support services for other clinical professionals—we’re all on the same team. Don’t be angered by the misinformed questions above, or by the stereotypes you might encounter in pathology, try and use them as teaching platforms within our community.

Capt. Hematologist Jean Luc Picard (right) takes endorsement from Chief Instrument Engineer Geordi LaForge (left) and while examining active Laboratory Data (center) speaks with clinical staff regarding temporary procedural changes for sending and holding PTT mixing studies while maintenance is being completed. [Source: Star TrekTNG]The whole point is that we’re in this together. Not just interdisciplinary teamwork that makes this year’s Star Lab theme so poignant, but teamwork across scopes. Those calls and messages we get in our managers’ offices or various bench top phones are part of our team too. It’s about the patients. We already know we contribute over 70% of clinical relevant information in every patient’s chart—some diagnoses like cancer rely completely on pathologist interpretation for screening, diagnosis, staging, and treatment recommendations.

While EMH Drs. Mark I and Mark II receive their “bad” results, it’s all part of a larger picture. As a note, “panic results” rarely illicit the expected reaction in the nurses and physicians we report them to. These doctors would think our current medical practice standards medieval, anyway… [Source: Star Trek Voyager]Here are a few examples of effective communication you could keep in mind.

For any Laboratory Professionals reading:

Instead of this: “Our policy is to reject clotted CBCs, we need a redraw, sorry.”

Try this: “While policy says to reject clotted CBCs, it’s not just because it could affect your PLT count. Other cell counts may be affected, and micro-clots can jam up the sensitive lines in the analyzers shutting them down for a while and affecting other patients’ results.” Try and realize that clinicians really do rely on those results! First and foremost, many clinical decisions are made on that last pending result for the next step of treatment. Whether it’s a PLT count or an acetone level, every result matters.

Try this: “Because room numbers can change so quickly, we can’t use them to properly identify a specimen or patient. Do you have any of the following information…?” Understand that doctors, nurses, etc. aren’t always calling the laboratory from a private area. Thus, with so many people walking around a medical unit, a name might not be an option for them to use—room numbers are a sort of code for HIPAA compliance.

For any Clinicians reading:

Instead of this: “I really need you to rush that type and cross, quickly.”

Try this: “What can I do to help facilitate quicker turn-around for getting these units available for my patient?” Not only will you have started a conversation with the bench tech working on crossmatches, but you’ll demonstrate awareness of the complex process of safety/reportability blood bank goes through. Understand that Blood Bank is one of the more highly regulated aspects of laboratory medicine; FDA guidelines treat blood products as both a controlled substance and a tissue transplant, effectively.

Instead of this: “You have to run these samples because the patient is a hard stick.”

Try this: “What would be the minimum amount sufficient to run a particular test?” and if you need more information, simply ask! You’d be surprised how much the lab scientist on the phone would know about a particular testing method. Understand that QNS guidelines for specimens are not arbitrary amounts for the sake of covering repeats or mistakes in analysis. They are there to ensure quality results based on research and efficacy for a given instrument or method.

We all get angry. Especially at work, when our labs might be understaffed, overloaded, and dealing with instrument failures or evil advanced genetically modified arch-nemeses on the floors like Laboratory Manager Capt. Kirk (pictured). [Source: Star Trek the Wrath of Khan]So, it’s okay to get frustrated. It’s human. But I’ve got to tell you, I have been on both sides of this now—as a laboratorian and a clinician—and what I see time after time are simple gaps in communication. If we want to get better, not just for us, but for our patients, we should play an active part in helping close that gap.

I gave a few examples above, but how do we really change anything? My answer: interdisciplinary collaboration—and that’s not just a buzz word from my finishing LMU! If we want to really change anything, we should start it. If you’re a bench tech, start a discussion with your senior staff, supervisors, and managers about what you feel could be improved. If you’re a manager, seek out those barriers and be an active advocate for your staff—you’re already an advocate for the lab. If you’re a clinical pathologist, coordinate with your colleagues on the floor, develop more relationships, reach out for more than just consults on sign-outs.

Don’t be afraid to be a voice for change. Staff meetings, in-services, and self-aware improvement can be facilitated with good leadership, organization, and clear goals! Even if things look grim and you’re on downtime with a full ER, or stuck in the middle of a volatile asteroid field, noted barriers to improved communication will always GET RESULTS. [Source: Star Trek TNG]Want to change the knowledge gaps between clinical staff and laboratory staff? Hold an in-service or distribute messages with the missing information. When I was at Northwestern Medicine’s Blood Bank, I was an instructor once a month for nursing staff regarding blood products and transfusion protocols. We walked through the process with new nurses from proper phlebotomy and labeling, to order sets, to transfusion, to dealing with transfusion reactions. It was excellent! It was a great time to answer many questions and also gain insight into the clinical side of transfusion medicine.

Want to make sure no more sideways or crooked labels get sent to your specimen receiving stations? Instead of relying on the shear number of rejections to speak for themselves, discuss policy changes with your management, find the barriers to this change of specimen labeling, even send flyers out with “best dressed” tube images—it’s worked, I’ve seen it!

Want to make sure pathology stereotypes aren’t continued into the future? Change them! I plan to! Everyday I think of new ways to facilitate a new model of inclusion for pathologists into clinical healthcare teams. They’re an integral member already, why not reach past that tumor board, or biopsy report?

It takes a village to run a lab, or a space station. An interdisciplinary team is the only way healthcare can continue to improve. Shapeshifting flexibility, shrewd business deals, passion for quality assurance, creative license, and scientific knowledge are only as good as the teamwork they are a part of—even if you have religious emissaries on your staff. Sharing knowledge and effective communication are critical for labs, clinicians, and our patients. [Source: Star Trek DS9]The bottom line: if laboratorians want to grow and advance into the changing fronts within healthcare, we should take this opportunity during Lab Week 2018 and really embrace our profession as part of an interdisciplinary team. We deliver exceptional care and advocate for patients through our quality work in detecting, reporting, and preventing illnesses. I recommended laboratory professionals become more actively involved with fellow clinicians to directly improve patient outcomes. Let’s teach, let’s change policies, let’s have interdisciplinary rounds, let’s have roundtable discussions, let’s advocate together.

Because, after all, aren’t we advocating for the same thing: our patients.

Thank you! See you next time, and Happy Lab Week!

–Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.